History of pre-syncope with no warning signs

[Jsher]

I am a 44-year-old man who has for the past decade has had pre-syncope episodes that come on with no warning signs and are brief but intense. These episodes have occurred while walking, standing and sitting. What they share in common is that I notice nothing wrong or unusual, no light-headedness or dizziness, when they suddenly strike me. I feel a rush in my head and I often start to pitch forward and feel as if I need to grab on to something to keep from falling. I do not feel dizzy or sense rotation -- I just feel as if I am about to black out. The sensation typically lasts only a second or two and I find myself instinctively flexing the muscles in my head and neck as I come out of it. Afterward, I often feel weak and flushed.

I have two episodes the past couple of weeks; I haven't tracked their frequency in the past but I would guess I would average close to one episode a month.

A bit more about me: I am 35 pounds overweight and have moderately high blood pressure an elevated cholestrol, both of which are being treated.

What testing, if any, would you suggest I undergo? What might be the cause of my symptoms and what can we rule out already?

[medicmommy]

I'd also recommend a 12-lead EKG and cardiac tests. This can be caused by your heart  pausing suddenly for a long moment, plaques in your carotid arteries, or a sudden drop in blood pressure for some other reason...Syncope can occur with Diovan, but it is usually because of the patient getting up too fast and their blood pressure was unable to compensate for the sudden position change...~MM

[Londres70]

I would recommend both if possible.    

[Jsher]

(1) I don't know much of my family history because I was adopted.

(2) I a taking Crestor 10mg daily for elevated cholesterol.

(3) The Diovan (80 mg) is a daily dose.

(4) I have begun tracking these episodes and will continue to do so.

(5) I will ask my doctor about an MRA/MRI. Would you recommend both be done?

Thanks for all your help.

[Londres70]

I would recommend you requesting an MRA/MRI of the head.  Discuss this possibility with your PCP/Family Physician.  These scans will give a good imaging of the vessels in the head/brain.  Any history of stroke/TIAs in your family?  

Are taking anything for the elevated cholesterol?  Is the Diovan 80 mg daily?    

Lastly, start tracking these episodes.  

[Jsher]

(1) My blood pressure has been dropping as I lose weight through exercise and diet; I've lost 12 pounds and my bp has dropped from 148/98 to 135/88. I am also taking Diovan though hope to be off it as I continue to lose weight.

(2) I don't smoke and rarely drink.

(3) I did have a stress test a year or two ago that turned up nothing significant. Any further testing I should consider?

(4)I have spoken with my family doctor, but other than the stress test, she suggested nothing else.

[Londres70]

I would recommend following up with your PCP/Family Physician for starts.  I would ask him/her for cardiac and vascular referrals if he/she cannot pinpoint the problem.

What have your blood pressures been running?  Hope you are not a smoker and/or drinker.  

Definitely sounds vascular in nature.